“Today’s the day I’m going to kill myself,” said David Durston. “You wake up and think, yeah, I’ll kill myself today. It’s today.” He sat in front of cheerful primary-coloured walls describing the darkness of his worst mornings. The Solace Centre for adults with mental illness, a low-slung bungalow in Ealing, west London, is a sanctuary for those with troubled minds – troubled in the mind-filling, heart-emptying way that can lead people like David, a softly spoken 55-year-old, to wake up feeling that this day could be his last.
He isn’t alone in the struggle. Across Europe, men are around four times more likely to die by suicide than women. More men in the UK have died by suicide in the past year than all British soldiers fighting in all wars since 1945. According to the latest figures from the Office for National Statistics, what they categorise somewhat obliquely as “intentional self harm or events of undetermined intent” account for over 1% of all deaths, killing three times more people than road accidents, more than leukaemia, more than all infectious and parasitic diseases combined. More than 6,000 people in the UK died by suicide in 2013; 78% of them were men.
These numbers are the aggregate of thousands upon thousands of unique untold stories, of men who didn’t make it. David, who works at a local garage but lives alone, is one of the many thousands more who struggle not to join them. “One day I’m great, I’m terrific,” he told me, left hand rummaging in the palm of his right. “The next, I’m low, I’m thinking of suicide, about the ways that I can die.”
To fully understand suicide would require the impossible – to know what the dead were thinking. It is an act that precludes the testimony of the only witness who really matters. Notes are only left in around a quarter of cases, but sometimes there are clues to be found in the online detritus of young lives ended too early. In most of his YouTube videos, Brett Robertshaw has headphones on, head bobbing rhythmically, fingers flashing up and down the fretboard of his bass guitar. His talent had gained him a following; some of these videos attracted 40,000 views. One is different. In it he sits in front of the camera – a red-haired, matter-of-fact boy. He’s shy and serious, quietly answering questions from his online following.
On his Ask.fm page, while Brett’s written responses to questions about his life from other users are generally funny, sharp and acerbic, a few give pause.
Question: “What was the last lie you told?”
Brett: “I’m OK.”
Question: “Your (sic) in your own movie are you the good guy or the bad guy? and why?”
Brett: “I’m the extra, because fuck that shit.”
Brett wrote over 7,500 tweets in less than three years. Most are digital snippets quite typical of a young male life, but there were also infrequent, intense bursts of sadness and resignation. Struggles to sleep. Anger and isolation. Alcohol as a coping mechanism. On 14 May 2014, unbeknown to family and friends, Brett began to draft a long and eloquent message for his personal website. It began: “The truth is, if this post is live, then chances are, I’m probably not here any more.”
He described a life “void of all emotions except sadness and worry”, fixated on worst-case scenarios and low on self-esteem. He wrote of “friendships” with inverted commas. His guitar playing was, he wrote, “just something that passed the time a bit”. Compliments only made him feel worse. When he finally sought treatment, worry about the appointments prevented him sleeping, while antidepressants made him feel nauseous. His conclusion was heartbreaking in its self-condemnation. “It’s entirely my own fault, and only my own lack of willpower and strength of mind is to blame.” On 5 July, the summer day when he ended his life at his home in Blackpool, Brett Robertshaw was still only 21 years old. One week later the explanatory message he had drafted over the previous months automatically posted to his website.
The Suicide Gene
Is it ever possible to pinpoint before it’s too late those, like Brett, at risk of suicide? Dr Zachary Kaminsky, assistant professor of Psychiatry and Behavioural Science at Johns Hopkins University in Baltimore, is at the forefront of efforts to identify what has colloquially been termed a “suicide gene”. “Stress is like driving,” Kaminsky says. “You can drive really fast, and that can be useful, but you have to be able to slow down.” His team compared brains of those who died by suicide and those who didn’t. They had an inkling that for those who died by suicide, a gene called SKA2 might be, in effect, acting as a faulty brake pad, failing to control stress.
By looking at just this single gene, Kaminsky’s team was able to predict with 80-90% accuracy whether an individual in their research group had thoughts of suicide or had made an attempt. More research is needed, but signs are positive that in the future a simple blood test may provide at least some indication of suicide risk. Whether SKA2 could also shed light on gender differences in suicide is not yet clear. “It is linked with the cortisol system and this system does interact with the oestrogen system,” mused Kaminsky, “so I suppose it’s possible”.
Others, such as professor Rory O’Connor, a psychologist at Glasgow University, who was recently elected President of the International Academy of Suicide Research, are extremely wary of the idea that there is some magic “suicide gene” to find. “It’s just a vulnerability factor, a test will never tell us why, he said. “It’s more important we identify the social and environmental factors.”
In Glasgow, where O’Connor is based, those from the poorest areas are 10 times more at risk than those from the richest. Research published in the British Medical Journal in 2013 showed that during the 2008 recession, English regions with the largest rise in unemployment had the largest increase in suicides. However, as O’Connor tells me, “the conundrum is that most people who die from suicide are in work”. Similarly, while mental illness is a very significant risk factor – as many as 90% of suicides occur in the context of mental illness – in O’Connor’s view, “it’s not ultimately the reason people kill themselves”.
Most academics think the answer to this complex “why” question is a combination of numerous different risk factors and negative life events that can push vulnerable people over the edge. Muddling the question further is a puzzle that has intrigued researchers for generations: it is true that men are much more likely than women to die by suicide, by a factor as high as six in countries with the highest overall rates. However, it is equally true that women are around three times more likely to make an attempt. This difference is normally attributed to method; men are more likely than women to choose high-lethality means, such as hanging. This begs a sensitive question: when is a suicide attempt not, in fact, an attempt to die?
An Honourable Death
Clinical psychologist Dr Martin Seager, a consultant for the Central London branch of the Samaritans whose work focuses on male psychology, traces the paradox back to gender. “Women are, in general, more prepared to seek help and show their distress. A female attempt is often closer to a cry for help, hoping for a response.” Typically, the male is seeking a different outcome. According to Seager, “when he makes a suicide attempt, he doesn’t want anyone to hear it, he wants to succeed”. He compares the action to a soldier “seeking an honourable death”.
Suicide jumped up the political agenda in early 2015 when the deputy prime minister Nick Clegg called for an overhaul of how the UK’s National Health Service tackles suicide. He proposed the widespread adoption of a “zero suicides” approach, following a campaign by The Henry Ford Health System, a healthcare provider based in Detroit, Michigan, which decreased the rate of suicide in its patient population by 75% in its first four years. The strategy, which has already inspired a similar approach in Merseyside, includes training all staff in suicide prevention, developing a system for staff to check in with patients by phone, and assigning patients different levels of risk and accompanying protocols. In the past two years, not a single suicide has been recorded at the Henry Ford Health System.
However, a whole country and a seemingly endless list of possible risk factors is more difficult to deal with. “It can feel overwhelming, like you are trying to chase the world,” Alana Atkinson, project manager for Scotland’s Anti-Suicide Initiative says. Yet Scotland, a country that has historically suffered higher rates of suicide than the rest of the UK, shows that a strategic, comprehensive approach can have some effect.
In 2002, following the release of a report, The Sadness of Young Men, detailing Scotland’s disproportionately high male suicide rate, the Scottish government announced its intention to reduce suicide by 20% in the space of 10 years. When 2013 came around, rates were down by 19%. The country’s Choose Life strategy focused on local coordination. A suicide prevention coordinator was nominated in each area, while funding to all local authorities for suicide prevention was protected. Improving the frontline response, raising awareness and tackling stigma, so that people felt more able broach the issue of suicide with their own families, was vital in reducing the rate.
The most important breakthrough was to make suicide part of the national conversation, but talking about problems often seems more difficult for men. The motley old crew at The Shed, in a community centre at the bottom of a housing estate in London’s Camden, were children of the post-war years. “You have a more domestically-oriented quiet masculinity,” Kings College historian Lucy Delap told me of that period. “Nazi masculinity was extreme and violent, whereas to be a British man was to be a quiet, restrained, self–controlled man emotionally.”
The Baby Boomers
The denizens of the Camden Shed are more comfortable working shoulder to shoulder than talking face to face, with The Shed recreating the habit and environment of their former, all-male workplaces. They break at lunchtime, have a brief chat. But then it’s back to work. Any therapeutic element is hidden under a heavy layer of sawdust, glue, sweat, and the sound of machines.
The idea behind the The Shed, a movement that started in Australia, is that older men, who slip quietly into loneliness, need a place to go to be with other men. Suicide rates among men over 55 have risen by 12% in the last decade in the UK. A 2012 Samaritans report identified isolation, unemployment, and lack of communication as particularly relevant risk factors for this age group. Men suffer more from social isolation in old age, and it’s predicted that the percentage of older men living alone will increase by 65% over the next 15 years as more men begin to outlive their partners. “Nobody comes to The Shed for the declared reason,” said Chris, a rakish 72-year-old jobbing actor in jeans and suede slip-ons. “It’s set up to address solitariness, but you won’t find people saying they are coming for that reason.” It’s therapy that dare not speak its name.
Kenneth padded over in an apron, a cerebral white-bearded former ceramic artist in baggy moss-green pantaloons. For him, a sense of changing masculinity is linked with war. “Think historically about the division of labour, the type of society, what you needed men to do. You can’t nurture a sensitive man if you need a war weapon.”
There’s a lot of gruff compassion in the strong, silent collective at The Shed. Raymond is a former dentist who lost his short-term memory after being struck by lightning on the golf course. Mick, a twinkle-eyed former carpenter, reached over to remove a large wood splinter from close to his friend’s eye. “You see, that’s right in your fucking eye you idiot. You’ve got to take care.” These men are retired and in many ways inured from the pressures of social change. Statistics suggest it is the next generation down, those in middle age, for whom we should worry the most.
The suicide rate for men aged 45-59 has increased by around 40% in a decade, but there’s more to it than that. If you log the age-disaggregated number of male suicides in England and Wales over the last 30 years into a table, something extraordinary becomes clear. In 1987, those aged 20-24 had the highest number of suicides. Five years on, in 1992, it was that same group, now aged 25-29. The pattern continues through 1997, 2002, 2007 then into 2012, when reaching the 45-49 bracket this cohort once again accounted for the highest number of suicides. This suggests that these late baby-boomers born between 1963-1967 have carried the highest risk of suicide with them from their teens all the way to middle age. The question is why?
The Samaritans’s 2012 report Men, Suicide and Society suggests that men in middle age should be considered part of a “buffer generation” caught between two competing ideas of masculinity. Like those older men at The Shed, like their own fathers, this generation is still wrapped up in the male ideal as stoical, independent breadwinner. However, the shifting standards of the modern world often make meeting these expectations impossible.
Figures from the Office for National Statistics show the average age a man divorces in the UK is now 45. This buffer generation was setting up home in a brave new era for the institution of marriage. Increasing numbers of women in the workplace, and corresponding individual pension funds, meant that increasing numbers of women had the option to leave. Many did; the divorce rate exploded from the late 1970s onwards, and only began to drop off again in the mid-2000s.
The effect of relationship breakdown can be catastrophic, with most research indicating that men are affected far worse than women. The Samaritans report found that “men in mid-life are dependent primarily on female partners for emotional support”. While women maintain their independent relationships, male friendships tend to drop away after the age of 30. Suicidal thoughts and suicide attempts were three times higher among divorced men, and two times higher among separated men compared to married.
What of the younger generation? Last year, Vice.com published an article on “the young British douchebag” (YBD), which followed a spate of American articles on the existence of the US rough equivalent, the so-called “bro”. Despite increased engagement with consumption and demonstrating a more metrosexual concern for his appearance that would have been unacceptable during earlier generations of masculinity, writer John Saward described the YBD thus: “He is a walking scorched-earth policy. He takes what he wants to satisfy some hedonistic impulse, and then he leaves her sobbing in a hallway with her friend on the other line. He wrings every moment of every drop of novelty. He is doing shots and never with a chaser, because moderation and restraint are for women and faggots and children. The only way to be a real man is to be a real man as ferociously as humanly possible. He goes all-in . . . ”
A response to this article defended the YBD as “a neutered generation lacking in role models, limping from the shadows of predecessors, who defined themselves by the wars they fought, the things they made and the fields they tilled”. It seems the fact that a man moisturises, or shaves his chest, or even wears eye-shadow, does not mean he will be any better at discussing or dealing with difficult emotions. Core masculine values endure. Suicide is the leading cause of death for men aged 20-34, accounting for more than a quarter of all deaths in this age group.
Surveying the research on male experience of mental health seems to support the view that masculinity is costing lives. Men access GP surgeries less than women. They are more reluctant to seek professional help for mental health issues, generally doing so only when crisis has already hit. Furthermore, according to a 2013 study published in the Journal of the American Medical Association, lower rates of depression diagnosis among men may be because symptoms of depression that accord with notions of masculinity are not recognised as such. As one psychologist told me, “with men, we don’t even diagnose it as depression, we call it aggression or bad behaviour. Often getting drunk, or even violent . . . it’s just another symptom”.
The Talking Cure
Stephen Hoddell of the Bristol branch of the Samaritans, who in his 40 years as a volunteer has perhaps conducted more conversations with struggling men than anyone else, suggested to me that help “is just not a language men are comfortable using”. However, the Samaritans phone-lines that he mans are almost 50% taken up with male callers. Those of the Campaign Against Living Miserably (CALM), an organisation set up specifically for men, cannot keep up with demand. “Men will talk, do talk, want to talk,” said CALM Director Jane Powell, “but they do find it hard to talk to mates and wives about stuff, because the cultural pressures are very rigid”.
Dr Martin Seager at the central London Samaritans sees a danger in approaches to help men that, in essence, tell them to act more like women. For Seager, the core of the problem with that approach is that it goes against evolutionary biology. “The way I look at it, if men have evolved as fathers, protectors and survivors, they are going to feel life is worth living to the extent they can provide and protect.” In his view, the problem comes when the world changes and men are no longer able to fulfil this traditional role.
With this subtle change of emphasis, the whole question of how best to address male suicide is subsumed by a deeper ideological battle – one that strikes at the very heart of what it means to be a man. Mike Buchanan, 58, is founder of the world’s first political party for men’s human rights, Justice for Men & Boys (and the women who love them). He is also a prolific self-publishing author of volumes including David and Goliatha and Feminism: The Ugly Truth. “There is absolutely nothing wrong with traditional masculinity, absolutely zero wrong with it,” he said. “I think that idea is batshit insane.”
Buchanan and others prominent in the online “manosphere”, where he has developed a following, are generally “essentialists”, believing male and female behaviour is predominantly biologically determined, rather than the product of social influences. From this point of view, the problem lies not with stoicism or other elements of traditional masculinity, but with their dilution in what Buchanan believes is a “gynocentric world . . . run to pander to the wants and needs of women all along the way”. This perspective is blunt: the rise of women has triggered the fall of men.
Most feminists reject the idea that increasing gender equality needs to be such a zero-sum game, but many do concede that increased equality for the sexes has presented certain difficulties for men. “Feminism has brought up a lot of challenges for men in terms of reflecting on position,” said
Dr Victoria Robinson, director of the Centre of Gender Research at the University of Sheffield. “However, we don’t often hear from men or listen to men’s voices, and that is absolutely vital.
If feminism is viewed as only for women, then we’re responsible for that.”
Whatever the theories, those suffering with mental health problems, vulnerable men and women alike, often struggle to make their voices heard. In November, David and the other members of the Solace Centre in Ealing received bad news. Ealing council, struggling to slice over £90m pounds from its budget, was considering this facility, with its four staff and £150,000 of annual running costs, for closure. Scared of losing a centre they consider their lifeline, the members started a campaign. A website was quickly built, piles of signs were constructed. They lobbied councillors and pounded the local streets, gathering over 1,600 petition signatures.
Then, in early January, with the council’s final decision still in the balance, one of the male members stepped under a train at nearby Ealing Broadway station. It felt like a defeat for everyone. “I was surprised to hear, very surprised, because when I last talked to him, he was happy,” said David. “But somebody told me it’s like that sometimes. They feel better because they know they are going to die.”
The Samaritans’ 24-hour helpline is 08457 909090.